乳腺癌长期行三苯氧胺治疗对乳腺第二原发癌的影响

对１９８５年１月～１９９０年１２月６年间收治的８７４例女性乳腺癌进行了回顾性分析。发生乳腺第二原发癌的病人共２１例。根据是否应用三苯氧胺治疗将病人分为２组。其中应用三苯氧胺治疗（三苯氧胺组）的病人５２３例，平均随访时间为７．８年（４．５～１０年），三苯氧胺治疗剂量为每天２０ｍｇ，服用时间为２～５年，有８例病人发生乳腺第二原发癌，发生率为１．５％。未用三苯氧胺治疗（对照组）的病人３５１例，平均随访时间为７．０年（５～１０年），有１３例病人发生乳腺第二原发癌，发生率为３．７％。三苯氧胺组的乳腺第二原发癌发生率明显低于对照组。经统计学检验，两组间差异有显著性（Ｐ＜０．０５）。结果提示，三苯氧胺有预防乳腺第二原发癌的作用     

平消胶囊联合三苯氧胺治疗乳腺增生

目的:观察平消胶囊与三苯氧胺合用治疗乳腺增生的临床疗效.方法:将520 例乳腺增生患者随机分为治疗组和对照组各260例,对照组单用三苯氧胺治疗,治疗组在对照组相同治疗的基础上加用平消胶囊治疗.结果:治疗组总有效率为90.4%,对照组总有效率为67.7%,两组有显著性差异(P＜0.01).结论:平消胶囊与三苯氧胺合用治疗乳腺增生疗效满意,优于单用三苯氧胺.     

平阳霉素注射治疗单纯乳腺囊肿的疗效观察

乳腺囊肿是妇女常见疾病,发病率占所有女性的7％左右。笔者于2005年2月至2007年12月期间对本院乳腺科门诊经乳腺触诊、超声初诊为单纯乳腺囊肿的56例患者进行平阳霉素注射治疗,同期的69例患者则行单纯穿刺抽液治疗,并将两种治疗方法进行对比。现报告如下。     

三苯氧胺治疗乳腺增生病635例分析

本文报道用三苯氧胺治疗乳腺增生病635例。年龄20~55岁，其中20~30岁70例（26．77%）；31~40岁306例（48．18％）；41－50岁107例（16．85％）。全部病例均用三苯氧胺治疗，显效540例（85％），有效51例（8％）。三苯氧胺治疗乳腺增生病，副作用少，疗效好，是目前较为理想的药物，值得推广应用。     

三苯氧胺与化疗联合应用治疗晚期恶性肿瘤临床观察

为探索三苯氧胺和化疗联合治疗恶性肿瘤的协同作用。对４０例晚期恶性肿瘤患者进行了随机分组对照试验。２０例采用三苯氧胺加化疗（实验组），２０例单纯化疗（对照组），两组化疗方案相同。初步结果显示，两组总有效率分别为７５％（１５／２０）和４５％（９／２０），两组疗效相比有显著性差异。毒副作用两组无显著性差异，未见三苯氧胺明显不良反应。表明三苯氧胺有化疗增敏剂之作用，有助于改善化疗效果。     

塞来昔布联合三苯氧胺对甲基亚硝基脲诱导大鼠乳腺肿瘤的影响

  目的   塞来昔布联合三苯氧胺对甲基亚硝基脲（MNU）诱发大鼠乳腺肿瘤的影响。  方法   雌性3周龄SPF级Sprague Dawley（SD）大鼠140只随机分成对照组、塞来昔布组、三苯氧胺组及联合组,腹腔注射MNU后分别给予不同的方案进行干预,观察各组大鼠乳腺肿瘤的发生率、肿瘤的体积及COX-2和C-erbB-2的表达。  结果  塞来昔布组、三苯氧胺组与对照组比较,肿瘤发生率低,肿瘤体积小;联合组肿瘤发生率最低,肿瘤体积最小。塞来昔布组、联合组大鼠乳腺肿瘤COX-2、C-erbB-2的阳性表达率低于对照组和三苯氧胺组（P < 0.05）。  结论   塞来昔布和三苯氧胺对MNU诱发大鼠乳腺肿瘤的发生均有预防抑制作用,两药联合效果更好。      

奥曲肽诱导乳腺肿瘤细胞凋亡的实验研究

目的初步阐明奥曲肽（Ｏｃｔｒｅｏｔｉｄｅ，ＳＭＳ２０１，９９５，商品名：善得定）与乳腺肿瘤细胞凋亡的关系。方法取手术切除的１６例女性乳腺癌标本，制备肿瘤单细胞悬液，加入善得定（０．１μｇ／ｍｌ）和三苯氧胺（１μｇ／ｍｌ），用ＤＮＡ断端标记法（ＴＤＴ法）分析药物及ＥＲ、ＰＲ对乳腺肿瘤细胞凋亡的影响。结果加入善得定４小时后凋亡率为１０．６±６．９％，１８小时为１４．３±８．８％，ＥＲ（＋）ＰＲ（＋）组４小时善得定凋亡率为１４．３±５．７％，１８小时为２０．２±７．１％，加用三苯氧胺后１８小时组凋亡率为２６．３±８．９％，而ＥＲ（－）ＰＲ（－）组４小时善得定组凋亡率为４．４±３．０％，１８小时为６．５±４．０％，加用三苯氧胺后１８小时组凋亡率为８．８±４．１％，与ＥＲ（＋）ＰＲ（＋）组相比有明显差异（Ｐ＜０．０５）。结论善得定可诱导乳腺肿瘤细胞凋亡，且短时间内即可达到一定的凋亡率，善得定对ＥＲ（＋）ＰＲ（＋）的乳腺肿瘤细胞较敏感，而对ＥＲ（－）ＰＲ（－）组则基本无影响，善得定加用三苯氧胺的治疗有望成为乳腺癌患者术后一个新的辅助生物治疗手段     

三苯氧胺治疗乳腺增生病635例分析

本文报道用三苯氧胺治疗乳腺增生病６３５例。年龄２０￣５５岁，其中２０￣３０岁７０例，３１￣４０岁３０６例，４１￣５０岁１０７例，全部病例均用三苯氧胺治疗，显效５４０例，有效５１例，三苯氧胺治疗乳腺增生病，副作用少，疗效好，是目前较为理想的药物，值得推广应用。     

治疗乳腺增生常用药物疗效比较

目的:比较乳腺增生治疗药物的疗效。方法:选择临床诊断为乳腺增生症的患者随机分成四组,分别给予乳癖消、乳康片、平消胶囊、三苯氧胺治疗各100例,对比观察疗效及不良反应。结果:总有效率分别为33%、40%、89%、85%。前三种中药制剂未见明显不良反应,三苯氧胺有不良反应。结果:对于保守治疗的乳腺增生症应根据具体情况,主要选择中药制剂,慎用三苯氧胺。     

三苯氧胺辅助治疗早期乳癌的对照试验

本文分析(1983年12月31日统计资料)三苯氧胺辅助治疗早期乳癌6年多,中数随访45月的全部对照试验结果.作者共收治乳癌患者1285例,年龄≤75岁。经乳腺全切除术或乳癌根治术后,随机分组。除外不适宜本研究患者,562例服三苯氧胺(10mg,每日2次,服二年或至复发);567例为对照,不作进一步的治疗。结果:三苯氧胺组复发或死亡152例;对照组则为220例(P<1.0001)。三苯氧胺治疗失败率比对照     

Ultrasonographic evaluation of palpable breast masses: analysis of 134 cases

Sonography has become a helpful adjunct to mammography mainly for a differential diagnosis between simple cysts and solid masses. The authors examined by ultrasound 134 palpable masses in the breast which had been previously evaluated by clinical examination and mammography and then submitted to biopsy or fine needle aspiration. The exact diagnosis of a simple cyst was made in 94.1% of the cases, whereas the diagnosis of fibroadenoma was made in 80% of the cases. Ultrasound examination proved to be useful in patients with dense breasts: in this group, 82.1% of the patients with a histologic diagnosis of benign status had a correct ultrasound diagnosis. In agreement with other authors, we believe that breast sonography has no part in screening programs.     

三阴性乳腺癌中MMP-9的表达及意义

目的:探讨三阴性乳腺癌(TNBC)中基质金属蛋白酶-9(MMP-9)的表达及意义.方法:收集2012年1月至2013年12月乳腺浸润性导管癌共158例,应用免疫组织化学及荧光原位杂交技术将乳腺癌分为65例TNBC、93例非TNBC.免疫组织化学检测MMP-9的表达情况,明确MMP-9在二组间表达的区别.分析MMP-9在TNBC中与临床病理特征关系,并随访65例TNBC患者3年复发或转移率,探讨MMP-9表达与3年复发转移率间的关系.结果:TNBC中MMP-9表达明显高于非TNBC(P<0.05);TNBC中MMP-9表达与年龄和肿瘤大小无关(P>0.05),与TNM分期、组织学分级、淋巴结状态及脉管浸润有关,差异具有统计学意义(P<0.05);MMP-9阳性的TNBC患者3年复发转移率高达76.09%,明显高于MMP-9阴性组47.37%,差异具有统计学意义(P<0.05).结论:TNBC中MMP-9表达明显高于非TNBC,MMP-9与TNBC浸润转移有关,对预测3年复发转移有明显意义.     

Using biological measurements, can patients with benign breast disease who are at high risk for breast cancer be identified?

In order to address the question of whether biological measurements might identify women with benign breast disease (BBD) at particular risk for breast cancer, analyses were performed on cyst fluids aspirated from patients presenting with palpable breast cysts. Electrolyte profiles showed that cyst fluids may be divided into major subpopulations which differ in terms of histological appearance of cyst lining epithelium, pattern of cyst presentation, and levels of other fluid constituents such as androgen conjugates and epidermal growth factor. Analysis of cyst fluids from 18 patients who subsequently developed breast cancer 1 to 8 years later showed that 12 individuals had group A cysts, three had group B cysts, and three presented with a mixture of the two types. Therefore, although this represents an increased proportion of group A cysts as compared with the total population of cyst fluids studied over the same time period, individuals subsequently developing breast cancer were not confined to one subgroup of cysts. Androgen conjugate and growth factor content also did not predict for subsequent cancer. At the present time, it is therefore concluded that biochemical measurements in cyst fluids cannot accurately identify women likely to develop breast cancer. However, the routine aspiration of cysts does provide the opportunity to monitor the local microenvironment of the breast.     

乳腺癌复发时间的临床病理因素及DCE-MRI预测价值研究

目的:分析乳腺癌患者的临床病理特征、DCE-MRI形态学表现及动态参数指标在预测患者复发时间中的价值。方法:回顾性分析2012年11月至2014年12月在我院就诊,经术后病理确诊并有术前乳腺MRI检查资料的乳腺癌患者,经过3年以上时间随访,依据病理证实或定期影像检查随访确诊为复发的患者58例,对比分析早期复发（术后≤2年）和晚期复发（术后＞2年）患者的临床病理和DCE-MRI特征。结果:在临床病理特征分析中,58例患者2年内乳腺癌术后复发率最高,平均复发时间为23个月（5~49个月）,首发复发转移部位为骨转移多见。淋巴结转移数＜4枚时多见于晚期复发组,≥4枚时多见于早期复发组,二者之间有统计学差异（P<0.05）;HER-2阳性多见于早期复发组,阴性多见于晚期复发组,二者之间有统计学差异（P<0.05）。早期复发患者死亡率（39.39%）高于晚期复发者（4.00%）,且二者具有统计学差异（P<0.05）。在DCE-MRI特征中,早期复发组与晚期复发组间Vpmax值、MaxConcmean值、AUCmean值及MaxSlopemean值存在差异,且差异具有统计学意义（P<0.05）。结论:乳腺癌患者的淋巴结转移情况、免疫组化表型及DCE-MRI动态参数预测乳腺癌患者的复发时间有一定的价值。     

Readministration of tamoxifen after adjuvant therapy for recurrent breast cancer

BACKGROUND: Previous series concerning tamoxifen (TAM) rechallenge did not obtain satisfactory results. Using stricter criteria, we now assess the usefulness of readministration of TAM as an initial therapy for patients with recurrent breast cancer. METHOD: The eligibility criteria were postmenopausal, estrogen receptor (ER) positive or unknown, at least 12 months of adjuvant TAM, a 6-month or longer drug-free period and no previous therapy after recurrence. A total of 10 patients were enrolled. TAM was administered in daily doses of 20 or 30 mg. RESULTS: The mean age of the patients at the time of recurrence was 64.8 years. The receptor status was positive in 8 patients and unknown in 2. The median disease-free interval (DFI) after mastectomy was 71.7 months. A complete response was observed in one patient, a partial response in 6, stable disease in 2, and progression in one. The response rate was thus 70%, with an additional two patients showing no progression over 6 months. Although only one patient with a DFI of less than 48 months showed a positive response, all patients with a DFI longer than 48 months showed a clinical response. The duration of response was less than 12 months in 3 patients and longer in 4. CONCLUSION: The post-adjuvant readministration of tamoxifen is a useful first choice therapy for postmenopausal recurrent breast cancer patients with positive ER and longer DFI.     

E-cadherin在不同分子分型乳腺癌中的表达及其在三阴性乳腺癌中的临床意义

目的:探讨不同分子分型乳腺癌中E－钙黏素蛋白（E-cadherin）的表达及其在三阴性组中的临床意义。方法:收集2012年1月至2013年12月乳腺浸润性导管癌共188例，应用免疫组织化学及荧光原位杂交技术将乳腺癌分为Luminal A型49例、Luminal B型41例、HER-2阳性型44例，三阴性组（TNBC）54例。免疫组织化学检测的E-cadherin的表达情况同时分析E-cadherin在TNBC中与临床病理特征关系，并随访54例TNBC患者3年复发或转移率及PFS。结果:乳腺癌中E-cadherin阳性率为52.13%，Luminal A型组阳性率为63.27%、Luminal B型组阳性率为63.41%、HER-2阳性组阳性率为43.18%及TNBC组为42.59%，四组间阳性率差别具有统计学意义(χ2=7.89,P<0.05)。TNBC与HER-2阳性组间差别无统计学意(χ2=0.003,P>0.05)，而TNBC组阳性率较Luminal A型组和Luminal B 型组均明显降低，差别具有统计学意义(42.59% vs 63.27%，χ2=4.40，P<0.05，42.59% vs 63.41%，χ2=4.05，P<0.05)；TNBC中E-cadherin阳性表达与年龄无关 (P>0.05)，与肿瘤大小、TNM分期、组织学分级、淋巴结转移状态及Ki67负相关，差别具有统计学意义(P<0.05)；TNBC总体3年复发或转移率高达55.56%，无病生存率为44.44%。E-cadherin阳性组复发转移率为39.13%，E-cadherin阴性组复发转移率为67.74%，差别有统计学意义（χ2=4.38，P<0.05），3年无疾病进展时间（PFS）E-cadherin阳性组明显优于阴性组（P<0.05）。结论:不同分子分型乳腺癌中E-cadherin表达不同，E-cadherin阳性表达与肿瘤大小、组织学分级、分期及浸润转移呈负相关，对预测3年复发转移有一定意义。     

Diagnostic efficiency of Sestamibi gammagraphy and Doppler sonography in the preoperative assessment of breast lesions

Introduction It would be desirable to have preoperative methods that allow an adequate selection of patients with breast lesions to rule out breast cancer: The aim of the present study is to evaluate the efficiency of preoperative Sestamibi gammagraphy and Doppler sonography regarding the differential diagnosis of malignancy in breast lesions. Material and methods A prospective observational study was conducted on 88 consecutive patients with breast lesions. All the patients underwent preoperative Doppler sonogrpahy with an echo-enhancing agent and Sestamibi gammagraphy. All the patients had histopathological study of the surgical specimen to compare with the result of the preoperative techniques. These comparations were done both for the overall series and separately for palpable and non-palpable lesions. Results In the overall series results, both tests separately and the two combined, are related significantly to the malignant histological diagnosis (p<0.001). In palpable lesions, there is a considerable increase in sensitivity, and especially in specificity, attaining 100%, with the combination of both tests. In non-palpable lesions, a relationship was only found between the results of the Sestamibi gammagraphy and the malignant histological diagnosis (93.3%; p<0.05). Conclusions Sestamibi gammagraphy and Doppler sonography are two efficient exploratory techniques in the preoperative assessment of malignancy in breast lesions, especially for palpable lesions, and this efficiency is greater when they are combined.     

两种乳腺癌相关基因联合检测的临床应用

目的:建立逆转录聚合酶链反应(RT-PCR)法检测乳腺癌人类表皮生长因子受体2(human epidermal growth factor receptor-2,C-erbB-2)和人乳腺珠蛋白（human mammaglobin,HMAM）基因表达水平,探讨其联合检测在乳腺癌诊断中的应用。方法:采用RT-PCR法,以β-actin为内对照,测定40例健康女性体检者、69例良性乳腺肿瘤和127例乳腺癌外周血中C-erbB-2和HMAM的表达量。结果:外周血中C-erbB-2和HMAM在良性乳腺疾病组和健康体检组的表达率无差异,乳腺癌组和良性乳腺疾病组以及健康体检组的表达率有显著性差异。HMAM和C-erbB-2联合检测的灵敏度显著高于单一基因。结论:RT-PCR联合检测外周血HMAM和C-erbB-2基因表达,可提高对乳腺癌诊断的灵敏度,有效辅助临床诊断乳腺癌。     

Mucocele-like tumour of the breast

Mucocele-like (ML) lesions of the breast are rare tumours and were reported as benign lesions that histologically resembled colloid carcinoma of the breast when first described about sixteen years ago. Only subsequent reports identified ML lesions associated with ductal hyperplasia or carcinoma. The Authors report an additional case of ML tumour of the breast and review the available medical literature. A young asymptomatic woman, without family history of breast cancer, presented with a palpable breast mass. As the radiological aspect was not typical of a simple cyst, the patient underwent a fine needle aspiration biopsy which showed a doubtful pathological pattern compatible with fibroadenoma. The patient underwent surgery and the gross examination of the surgically removed mass revealed multiple aggregated cysts containing mucinous material. Microscopic examination showed a ML tumour of the breast, with aspects of cribriform ductal hyperplasia.     

Epidermal growth factor content of breast cyst fluids from women with breast cancer or proliferative disease of the breast

Summary The intracystic electrolyte content is generally used to identify different breast cyst subpopulations: cysts containing high K+ levels have been associated with an increased risk of subsequent breast cancer. In order to define whether other biochemical features of breast cyst fluid (BCF) might further explain such an increased risk, we determined the content of epidermal growth factor (EGF), a known mitogenic factor for normal and transformed breast epithelium, in cysts of women with breast cancer or proliferative lesions of the breast (atypical ductal or lobular hyperplasia and proliferative disease without atypia).Median intracystic EGF levels were significantly higher in patients with breast cancer or atypical hyperplasia than in cysts of women without any clinical or instrumental evidence of proliferative disease chosen as controls (p < 0.05 and p < 0.01, respectively). In patients affected by proliferative disease without atypia, intracystic EGF levels were not different either from controls or from the other study groups. No significant difference among groups was observed in the prevalence of Na+/K+< 3 cysts, this being the most frequently observed type of cysts in all groups except in that with proliferative disease without atypia. No significant difference in EGF levels between cysts ipsilateral or contralateral to the biopsy was observed within each histological group.Our results indicate that EGF levels are higher in cysts aspirated from breasts with an associated proliferative pathology, either benign or neoplastic. The determination of intracystic EGF, combined with that of electrolyte content, might help to identify a subset of patients with gross cystic disease of the breast at potentially higher risk of developing breast cancer.